Hypothalamic Neurohormones
- Somatostatin
o Targets GH and TSH and Insulin, it inhibits them
- Dopamine
o Targets PRL, TSH, LH and FSH, it inhibits them
Anterior Pituitary Hormones of note
- GH
o Insulin like effects acutely, anti-insulin like effects chronically
- Prolactin (released in pregnancy and sexual activity/stress)
o Hormone most produced in excess by tumors
o Only hormone primarily under inhibitor control
Posterior Pituitary Hormones of note
- ADH (promotes water conservation, causes vasoconstriction)
o Diabetes insupidus results from either a lack of ADH or kidney inability to respond to ADH
Generalized Adult Hypopituitarism
- Partial or complete loss of anterior lobe pituitary function
- >50% due to tumors (adenomas), even if tumor is functional, mass may compress adjacent tissue causing
hypopituitary symptoms
- In children also see growth retardation and delayed puberty
o Isolated LH and FSH deficiency
In women: amenorrhea, regression of secondary sexual characteristics, infertility
In men: impotence, testicular atrophy, regression of secondary sexual characteristics
o Kallmann’s Syndrome
Genetic GnRH deficiency associated with midline facial defects, including anosmia (cant
smell), color blindness and cleft palate
o Isolated TSH deficiency
Hypothyroidism symptoms
o Isolated ACTH deficiency
No hyperpigmentation, weakness, hypoglycemia, weight loss, axillary and pubic hair loss
o Isolated GH deficiency
Pituitary dwarfism, not clinically detectable in adults
o Isolated Prolactin deficiency
Often elevated in hypoglycemic disease, due to low dopamine
o Sheehan’s Syndrome
Lactation doesn’t develop due to pituitary necrosis, commonly occurs after hypotension
secondary to postpartum hemorrhage, amenorrhea, hypothyroidism and inadequate adrenal
function
o Pituitary Apoplexy
Hemorrhagic infarction of pituitary tissue
Acute, severe headaches, stiff neck, fever, visual disturbances
o Empty Sella Syndrome
An enlarged sella containing a thin flattened pituitary at the base
Pituitary function is often normal, typical patient is female, obese, hypertensive, headaches
and visual field defects
Hyperpituitarism
- Pituitary Adenomas
o Benign neoplasms causing hormone secretion
o Microadenomas has no symptoms unless secrete hormones but Macroadenomas (>10cm) have
local symptoms
Impingement of optic chiasm, sever headaches
Hypothalamic invasion – loss of temp regulation
- Galactorrhea
o Lactation in those not breastfeeding, most common endocrinopathy associated with pituitary
adenoma
o Prolactinomas = 26% of all primary adenomas
o In women: estrogen deficieny, hot flashes, dyspareunia (pain on intercourse), amenorrhea,
infertility
o In men: headaches or visual disturbances, loss of libido
- Gigantism and Acromegaly
o Excessive GH almost always due to pituitary adenoma, 14% of pituitary adenomas
o If occurs in childhood it is known as pituitary giantism
Delayed puberty, hypogonadism often present
o If occurs in 30s-50s it is acromegaly
Swelling of hands and feet, protrusion of jaw, deep husky voice, skin thickens and darkens
Hyperpituitarism
- Corticotrope Adenomas (15%)
o Secondary Cushing’s disease, hypersecretion of ACTH
- Gonadotrope Adenomas (8%)
o Secrete LH and FSH, present in middle-aged men as headache, visual disturbances and acquired
hypogonadism
- Thyrotrope Adenomas (1%)
o Symptoms of hyperthyroid, goiter or pituitary mass lesion, increased TSH and thyroid hormone
- Non-functional Pituitary Adenomas (23%)
o Do not secrete excess hormones, diagnosed in older people
Posterior Lobe Disorders
- Diabetes Insipidus
o Deficiency of ADH, excretion of excessive amounts of very dilute urine, excessive thirst and
polydipsia (excess drinking)
o Diagnose with the water deprivation test
o Primary DI = only polydipsia and polyuria
o Acquired DI = Nocturia, polyuria and polydipsia
- Nephrogenic Diabetes Insipidus
o Compulsive water drinking (psycogenic)
